DELAFIVLD 
 
 An Inaugural. Dissertation 
 pulmonary Consumption 
 
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 Columbia (Hntoetsitp 
 
 College of iPjjpgtctans anb Hmrgeons 
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AN 
 
 91 naugural ^iggettatian 
 
 ON 
 
 PULMONARY CONSUMPTION 
 
 BY EDWARD DELAFIELD, A. B. 
 
 ■For want of timely care, 
 
 Millions have died of medicable wounds. Armstrong. 
 
 NEW- YORK: 
 
 PBINTED BY JOHN FORBES & CO. 
 78 WALL-STREET. 
 
 1816. 
 
7)3?-, 
 
 > ■■/. y 
 
TO 
 
 SAMUEL BORROWE, M. D. 
 
 ONE OF THE SURGEONS OF THE NEW-YORK HOSPITAL., 
 
 ' THIS DISSERTATION 
 
 IS DEDICATED, 
 AS A TESTIMONY OF GRATITUDE 
 FOR THE MANY VALUABLE PRACTICAL LESSONS 
 
 RECEIVED FROM HIM 
 
 BY HIS FRIEND AND PUPIL, 
 
 EDWARD DELAFIELD. 
 
INTRODUCTION, 
 
 THE attention of Physicians has for several years past 
 been excited to the consideration of that inveterate enemy 
 of the human race, the Consumption. Several works 
 have been published, new remedies proposed, and the 
 practice of former physicians revived with modifications 
 and amendments, in the treatment of this disease. At one 
 period, Consumption had been so long considered with- 
 out the reach of remedies, that it had almost ceased to 
 excite the enquiries of the learned in medicine. Fortu- 
 nately, however, the spirit of enquiry has revived ; and it 
 is believed that the treatment of this dreadful malady has 
 been so far improved, that many are rescued from its 
 grasp, and the sufferings of those who are still its victims, 
 are materially mitigated. Notwithstanding, it appears 
 that in this city the mortality from Consumption has 
 increased rapidly of late years. Formerly, its climate 
 was considered remarkably salubrious, and diseases of the 
 lungs were rare. Lieutenant Governor Colden, in a series 
 of remarks on the climate and diseases of New- York, 
 made seventy years ago, has the following observations : 
 " The air of the country being almost always clear, and 
 its spring strong, we have few consumptions or diseases of 
 the lungs. People inclined to be consumptive in England, 
 are often perfectly cured by our fine air ; but if there be 
 ulcers formed, they die. The climate grows every day 
 
VI 
 
 better, as the country is cleared of the woods ; and more 
 healthy, as all the people that have lived long here testi- 
 fy. This has even been sensible to me, though I have 
 lived but about twelve years in this country ; I therefore 
 doubt not but it will in time, become one of the most 
 agreeable and healthy climates on the face of the earth." a 
 These anticipations have not been realized ; but, on the 
 contrary, Consumption has become the prevailing disease 
 of our city. The causes of this increase of the disease are 
 numerous. We are told by Dr. Rush, that it is unknown 
 among the Indians of North iVmerica; that it is scarcely 
 known by those citizens of the United States who live in 
 the first stage of civilized life, and are generally called the 
 first settlers ; that it is less common in country places than 
 in cities, and increases in both, with intemperance and se- 
 dentary modes of life ; that ship and house-carpenters, 
 smiths, and all those artificers, whose business requires 
 great exertion of strength in the open air, in all seasons 
 of the year, are less subject to this disease than men who 
 work under cover, and at occupations which do not re- 
 quire the constant action of their lungs. By applying 
 these facts to the situation of this city, the causes which 
 have produced the increased mortality from consumption, 
 become evident. 
 
 1. The growth of the city, and consequent state of the 
 atmosphere, most distant from that of the pure air of the 
 country. 
 
 2. The increase of all those causes which have ener- 
 vated the bodies of men, and rendered them more suscep- 
 tible to the influence of a variable climate. Among these 
 are, augmentation of wealth, and consequently, luxury ; 
 increased dissipation, with its accompaniment, impru- 
 
 * Araer. Med. and Phil. Reg. Vol. I. 
 
Til 
 
 deuce in dress ; and extension of manufactures, affording 
 greater opportunity for sedentary employments, and expo- 
 sure to an insalubrious atmosphere. In general, the 
 causes are, all those circumstances which tend to remove 
 man farthest from that situation, in which the body is 
 possessed of the greatest vigour, and of course, least sub- 
 ject to disease, that of the savage. In proportion as the 
 city has enlarged, these causes have continued to increase, 
 and probably still will do so. But in Great Britain, they 
 appear already to have attained their acme, and as a con- 
 sequence of the improvements in medicine, the causes not. 
 increasing, the disease is on the decline. b 
 
 The following statement will show the proportion,, 
 which the number of those who die from consumption, 
 bears to the whole number of deaths, in this city, during 
 the last twelve years. 
 
 In 1804, 499 persons died from Consumption, and were 
 to the whole number of deaths, 2125 as 1 to 4.25. 
 
 In 1805. 
 
 ...462. 
 
 . ..2352 
 
 1806. 
 
 ...354. 
 
 ...2225 
 
 1807. 
 
 ...464. 
 
 ...2312 
 
 1808. 
 
 ...429. 
 
 ...2014 
 
 1809. 
 
 ...413. 
 
 ...2108 
 
 1810. 
 
 ...569. 
 
 ...2158 
 
 1811. 
 
 ...595. 
 
 ...2524 
 
 1812. 
 
 ...669. 
 
 ...2553 
 
 1813. 
 
 ...562. 
 
 ...2229 
 
 1814. 
 
 ...618. 
 
 ...2507 
 
 1815. 
 
 ...572. 
 
 ...1974 
 
 ,5.09 
 
 ,6.28 
 
 ,4.94 
 
 .4.69 
 
 .5.1 
 
 .3.79 
 
 .4.24 
 
 ,3.81 
 
 .3.96 
 
 .4.04 
 
 ,3.8 
 
 Dr. Lettsom observes, that Consumption is decreasing in Great Britain. 
 
 Med. and Phil. Reg, 
 
Vlll 
 
 From this statement it appears, that the number of 
 deaths from Consumption has gradually increased. The 
 average proportion during the period mentioned, is as 1 
 to 4.36. Nearly one fourth of all those who die in this 
 city are destroyed by this fatal disease. 
 
 These facts prove indeed that the power of medicine 
 has little control over so destructive a malady. But it 
 should not therefore paralyse our exertions. From what 
 has been done already, in improving our knowledge of its 
 nature and. treatment, a hope may be indulged that con- 
 sumption may one day, like many other maladies formerly 
 deemed incurable, be placed no longer among that num- 
 ber. 
 
INAUGURAL DISSERTATION 
 
 ON 
 
 PULMONARY CONSUMPTION. 
 
 THE term Phthisis, or Consumption, in its broadest 
 sense, is applied to all those diseases, in which the, system 
 sinks under a gradual waste of the powers of life. These 
 diseases may be divided into two great classes — 1. That 
 form of Consumption in which the lungs are~unafFected. 
 — 2. Phthisis Pulmonalis, properly so called, where the 
 lungs are the seat of the disease. 
 
 Under the first class are included, 
 
 1. Atrophia, or Consumption from want of nourishment, 
 or excessive evacuations, but without hectic fever; ex- 
 cluding all those forms of disease produced by immode^ 
 rate evacuations, in which the lungs become affected. 
 
 2. Tabes, accompanied with hectic fever, frequently at- 
 tended with disease of the mesenteric glands, and produ~ 
 ced most commonly by scrophula. 
 
 The second class, Phthisis Pulmonalis, to the consider- 
 
 B 
 
10 
 
 ation of which this essay will be more immediately con- 
 fined, may be also subdivided into, 
 
 1. Primary, where the lungs are the original seat of the 
 disease, and as a consequence, the general system becomes 
 affected. 
 
 2. Secondary, where the system being first reduced by 
 any debilitating cause, the lungs become secondarily 
 affected, as a symptom of the general disease. 
 
 These two forms of Consumption, although somewhat 
 similar in their symptoms, yet proceed from opposite 
 causes, and require opposite treatment. The one is a dis- 
 ease of pure inflammation ; the other of unmixed debility. 
 In the one, an active antiphlogistic treatment is necessary ; 
 in the other, the system requires all the support, which 
 tonics and good nourishment can afford. 
 
 Phthisis Pulmonalis is thus defined by Dr. Cullen, 
 u Corporis emaciatio et debilitas, cum tussi, febre hectica, et 
 expectoratione purulenta" This definition is peculiary in- 
 correct, because it leads us to neglect, the first stage of 
 the disease ; if the symptoms of an Incipient Phthisis 
 were stated to us, and we were asked, what was the dis- 
 ease, from this definition we would be perfectly at a loss 
 for an answer. Except the cough, none of the symptoms 
 there stated are to be found in the first stage of Consump- 
 tion. And yet that is as truly a part of it, and of as much 
 importance to the practitioner, as the last stage, which 
 alone is included inCullen's definition. 6 
 
 c The following- judicious remarks on this subject are made by Bayle, in his 
 " Recherches sur la Phlhisie Pulmonaire, d'apres la notion que j'ai donnee de la- 
 
II 
 
 Agreeably to this definition, in his view of Phthisis Pul- 
 monalis, Dr. Cullen makes ulceration of the lungs and 
 hectic fever essential to its existence, and seems rather to 
 consider the preceding symptoms a cause of this ulcera- 
 tion and fever, than as constituting an integrant part of 
 the disease. 
 
 Nor is the place assigned by him to Phthisis Pulmon- 
 ulis, in his Nosological Arrangement, more correct than 
 his definition of it He places it in the order Haemorr- 
 hagiae, and considers it merely as a consequence of Haemop- 
 tysis. Even if it were always excited by haemorrhage 
 from the lungs, it would be improperly thus placed; but 
 as that, even by Dr. Cullen, is considered merely as one 
 among many exciting causes, the arrangement is altogether 
 inadmissible. But if it be admitted, according to the 
 view which will be hereafter taken of Haemoptysis in this 
 treatise, that it is rather a symptom than a cause of Con- 
 sumption, the propriety of another arrangement will be 
 evident. Accordingly Phthisis Pulmonalis is placed by 
 Dr. Hosack, as one of the Phlegmasia^. This disposition 
 appears to be the most proper that has hitherto been 
 suggested, and as such I shall adopt it. But before we 
 
 Phthisie Pulmonale, on voit que je dois regarder eomme Phthisiques des 
 individus qui n'ont ni fievre, ni maigreur, ni expectoration purnlente : il 
 suffit que les poumons soient aff'ectes d'ime lesion qui tend a les desor- 
 ganiser et a les ulcerer. On ne doit pas reg-arder cette lesion uae simple cause 
 de la Phthisic, mais comme le premier temps de cette maladie, puisqne la Phthisie 
 est cette lesion meme dont la continuation et le developement successif amenent 
 la raort. II seroit done bien peu raisonnable de vonloir attendre, pour reconnoitre 
 la Phthisie Pulmonaire, quelle fut constamment parvenue a son dernier degre, 
 qui est le moment ou ses symptomes pathognomouiques sont bien marques." 
 
12 
 
 can ascertain the character and treatment of any diseases, 
 it is necessary minutely to examine their causes and symp- 
 toms. 
 
 Primary Phthisis Pulmonale first claims our attention. 
 Its predisposing causes may be mostly arranged into five 
 classes, as they depend on organization, age, sex, occupa- 
 tion and climate. 
 
 Organization predisposes to Consumption, by mal-con- 
 formation of the chest, which may be either natural or 
 accidental ; and an hereditary internal structure not de- 
 pending on the external form of the thorax. For it is 
 observed, that in some instances, those who have every 
 part of the external configuration, such as is generally at- 
 tributed to persons predisposed to Consumption, yet shall 
 be free from this disease ; while on the other hand, some 
 whose chests are externally perfectly well formed, have 
 been subject to catarrhal and inflammatory complaints of 
 the lungs, terminating in Phthisis. The form of chest pe- 
 culiar to many Phthisical patients, " is occasioned by the 
 sternal or breast-bone being pressed too much in upon the 
 substance of the lungs: thus the clavicles and shoulder* 
 blades are thrust out of their proper position, and made 
 to assume, in some measure, the form of wings, to which 
 indeed they have been with propriety compared, just 
 raised from the body and about to expand for flight. By 
 this internal direction of the sternum, the full expansion 
 and proper sweep of the ribs is likewise prevented, and 
 an unnatural curvature or prominence is occasioned on 
 either side of the breast, with a corresponding central de~ 
 
13 
 
 pression." d This is the peculiar form to which the term 
 narrow chest is generally applied. A flattened or any 
 other unnatural figure of the chest may produce the same 
 injury. 
 
 The thorax may become accidentally malformed from 
 any violence done to it, particularly during infancy. A 
 frequent source of it is the mode of fashionable dress 
 adopted by females. The corset, to which I allude, when 
 worn only with moderate firmness, and by those not 
 otherwise predisposed to Phthisis, serves but to add 
 elegance and beauty to the female figure ; but when ap- 
 plied with the object of converting into a delicate and 
 slender waist, one naturally otherwise, it cannot but do 
 injury. By immoderate pressure, it converts a well 
 formed chest into the deformed and narrow one, or at 
 least an approximation to it, which has just been de- 
 scribed. In our own city and time, too many fatal ex- 
 amples of the deleterious effects of this fashion have 
 occurred, to permit us to retain any- doubts on the 
 subject. 
 
 The internal constitution of the body predisposing to 
 Phthisis, independent of external form, has been generally 
 attributed to scrophula. English authors are particularly 
 fond of making Consumption another form of that Protaean 
 disease. We are much disinclined to concur in this 
 opinion from the fact, that the mass of those who labour 
 under the disease in question, and cases too, which, after 
 
 a Dr. Reid. 
 
14 
 
 death show that tuberculated state of the lungs, generally 
 ascribed to scrophula, evince no other of the numerous 
 symptoms of that disorder. The supposition that tuber- 
 cles were scrophulous, probably originated from the 
 opinion that they are diseased glands ; an idea now suffi- 
 ciently exploded. This hereditary predisposition we 
 know to exist, but of its mode of action we are totally 
 ignorant. In this city there are many melancholy exam- 
 ples of whole families successively falling victims to Con- 
 sumption, and sufficiently proving its hereditary nature. 
 But an hereditary predisposition does not necessarily pro- 
 duce Consumption. It is not uncommon for parents who 
 inherit this taint, to remain free from disease of the lungs, 
 by the pursuit of laborious occupations. Nor is it more 
 uncommon that the children of these very parents, whose 
 active industry had preserved their lives, and amassed 
 them wealth, should by being enabled to indulge in ease 
 and luxury, fall victims to an inherited Consumption. 
 
 So the females of a family are sometimes all consump- 
 tive, while the males are free from pulmonary disease, in 
 consequence of the more sedentary mode of life of the 
 former. 
 
 Although no period of life, from infancy to old age, is 
 exempt from Consumption, but all are liable to its attack, 
 yet at a particular age, it is observed to appear more fre- 
 quently than at any other. This period commences 
 about, or soon after the age of puberty, and terminates at 
 thirty-six; the period at which inflammatory diseases 
 most generally occur. 
 
15 
 
 Sex also gives a predisposition to Consumption. Fe- 
 males are more frequently affected by it than males. This 
 may be attributed to their greater delicacy of constitution, 
 and nervous temperament. Their comparatively sedenta- 
 ry habits of life add to this peculiar constitution. But 
 improper compliance with the requisitions of fashion and 
 taste constitutes not a small part of the greater susceptibi- 
 lity of females to Phthisis. Independent of the use of 
 corsets, the small quantity of clothing frequently worn 
 by them, under circumstances when it is most necessary, 
 is a fruitful source of mischief to their health. In the 
 coldest of our winter nights, will these fair devotees of 
 fashion issue from rooms, heated to a degree never expe- 
 rienced in our hottest weather, into the chilling air of 
 midnight, with less clothing than they use at noon, when 
 the sun exerts his greatest power. The next day brings 
 with it " a violent cold," and this cold is too frequently 
 the foundation of the Consumption which destroys them. 
 Occupation in life is another source of the ravages of 
 this disease. Particular occupations subject those engaged 
 in them to the respiration of air impregnated with foreign 
 materials, irritating the lungs, either by their chemical or 
 mechanical action. Substances acting mechanically upon 
 the lungs, are inhaled by stone-cutters, millers, hair-dres- 
 sers, bolters, coal-heavers, scythe-grinders, persons en- 
 gaged in pointing needles, chimney-sweepers, dressers of 
 flax and feathers, spinners in wool, and others employed 
 in similar occupations. Chemical agents are taken into 
 the lungs by manufacturers of acids, and all other volatile 
 
16 
 
 corroding substances. These materials constantly acting 
 upon the lungs, produce irritation and slight inflamma- 
 tion, terminating in Phthisis. The operation of any of 
 these causes is favoured when the occupation requires a 
 stooping or other awkward posture of the body to be 
 maintained. This cause may act independently of the 
 former also, and hence, students, and clerks writing at 
 their desks, taylors, shoemakers, &c. are liable to this dis- 
 ease. To the same causes are frequently added, a seden- 
 tary life, and confinement in hot rooms ; hence " a sur- 
 geon of London whose opportunities of observation are 
 very extensive, relates of the gilders of that city, who 
 work in heated rooms, that six out of seven are said to die 
 consumptive in their apprenticeship." Sedentary habits 
 of life, accompanied with hard study, and too intense ap- 
 plication of mind, predispose literary men to Consump- 
 tion. Loud public speaking, blowing on wind instru- 
 ments, glass blowing and other circumstances requiring a 
 laborious and continued action of the lungs, produce the 
 same effect. Any one of these causes may frequently 
 exist without injury, but their combined action seldom 
 fails to produce pulmonary disease. 
 
 Climate was enumerated under the predisposing causes 
 of Phthisis. That of our own latitude affords an example. 
 Its variableness, increased by contiguity to the ocean, 
 together with the prevalence of the moist and chilling- 
 north-east winds, is probably the agent which produces 
 this effect. The climate of Great Britain is not less un- 
 favourable to health, from similar causes, with the addi- 
 
17 
 
 tion of its greater moisture ; for it is observed that cold 
 combined with moisture is peculiarly dangerous to the 
 consumptive. On the other hand, inland countries, not 
 exposed to the moist winds from the ocean, are free from 
 this disease. Hence, the inhabitants of Russia and other 
 parts of the north of Europe, notwithstanding the severity 
 of their climate, are very little affected by Consumption. 
 The habits of the people, probably assist in producing 
 this immunity from pulmonary disease. Sir John Sinclair, 
 in a communication to Dr. Reid, attributes it in a great 
 measure to the employment of furs, cloaks and other 
 modes of clothing, which preserve an uniformity of 
 warmth throughout the body ; to the great care taken by 
 all classes of people to preserve their feet from cold and 
 damp ; to the different modes of communicating heat to 
 their apartments; and to the constant use of the vapour 
 bath. Similar observations were made by Dr. Cogan, 
 who in a letter to Dr. Beddoes, remarks that the people 
 of Holland are exempt in a great degree from this disease, 
 so prevalent among the English, and ascribes the difference 
 to the contrast observable between the two countries, in 
 the construction of their habitations,and in the peculiarities 
 of dress. 
 
 Debility from the want of accustomed stimuli, is men- 
 tioned by Dr. Hosack as another cause of consumption, 
 and he instances those confined in the State Prison. The 
 want of accustomed air and exercise, the deprivation of 
 the use of spirituous liquors and good diet, to which the 
 
18 
 
 prisoners had been accustomed before their confinement, 
 was observed by him to have produced this disease. 
 
 Depressing passions of the mind, and a. consequent too 
 free use of spirituous liquors have also been noticed by 
 authors among the predisposing causes of Consumption. 
 
 The last of these causes which I shall notice, is the dispo- 
 sition of the system to form calculous deposits in the lungs, 
 generally in consequence of a plethoric habit. Phthisis 
 from this cause however is rare ; of nine hundred patients 
 examined by Bayle, only four were of this description. 
 
 These various causes having either separately or con- 
 jointly predisposed the body to Phthisis, are most fre- 
 quently excited into action by a common catarrh ; which 
 becomes the more active by frequent repetition. The 
 danger arising from catarrh is not a little increased by the 
 popular mode of treating it : stimulating spirituous 
 drinks, and a vast variety of remedies of the same class are 
 the usual prescriptions. Almost every body has an 
 infallible remedy for a cold ; some of them innocent, but 
 many injurious. The common prejudice in favour of 
 " feeding a cold" increases the mischief, and unfortunate- 
 ly, the disease not generally affecting the system sufficient- 
 ly to destroy the appetite, as in many other maladies, na- 
 ture does not prevent the practice. Abstinence, cooling 
 acidulous drinks, with perhaps a gentle saline cathartic, 
 are the safest and most effectual remedies in curing a com- 
 mon catarrh, when of its usual slight form. At the same 
 time, inhaling warm air, by means of Mudge's apparatus, 
 is a valuable and grateful auxiliary to this treatment. Ca- 
 
19 
 
 tarrh is so common and generally so easily cured without 
 any consequent ill effects, that it is too apt to be neglected. 
 Many a patient, labouring under incipient Phthisis, has 
 been supposed to be affected by merely a " trifling cold,'* 
 and the only opportunity for curing the disease has been 
 lost. " The evil becomes irremediable before it calls ei- 
 ther the attention of the parents, the friends, or even the 
 physician, who has not been familiarly conversant with the 
 fatai consequences of this disease." 6 
 
 Pneumonia is not unfrequently an exciting cause of 
 Phthisis. Like catarrh, its frequent repetition is more 
 dangerous than a single attack. Pneumonia may indeed 
 act merely as a predisposing cause of Consumption, by 
 leaving the lungs in a debilitated and irritable condition, 
 favourable to the production of that disease ; but it is an 
 exciting cause, when in consequence of inflammation of 
 the lungs, suppuration follows, and vomica or empyema 
 is the consequence. This shews the close analogy be- 
 tween Phthisis Pulmonalis and ordinary Pneumonia. In 
 the first, the inflammation being seated in the cellular and 
 comparatively insensible portion of the lungs, is slow and 
 gradual, and the consequent suppuration forms in the same 
 manner ; while in Pneumonia, the membranous as well as 
 cellular portion of the lungs being involved in the disease, 
 the inflammation is rapid and violent, and must soon ter- 
 minate in either resolution or suppuration. Hence 
 Phtnisis Pulmonalis was appropriately called by Dr. 
 Rush a " Pneumonic ula." No word could more accu- 
 
 e Dr. Hosack. 
 
20 
 
 rately describe the nature of the disease. That acute ob- 
 server has drawn an excellent parallel between the two 
 diseases, and concludes with observing, " In short the 
 pneumony and Consumption are alike in so many parti- 
 culars, that they appear to resemble shadows of the same 
 substance. They differ only as the protracted shadow of 
 the evening does from that of the noon-day sun." It is 
 remarked, however, that all cases of Pneumonia termi- 
 nating in suppuration are not necessarily fatal. If a pre- 
 disposition to Phthisis do not exist, or the constitution 
 be not too much debilitated, a vomica may burst and be 
 discharged, and the patient recover. 
 
 A third exciting cause of Phthisis, is the suppression of 
 accustomed evacuations. These evacuations are the men- 
 ses, the lochiae, the discharges in Leucorrhaea, and from ul- 
 cers, fistulas and issues. Retention of the menses producing 
 Chlorosis, being a consequence of debility, does not excite 
 primary Phthisis Pulmonalis, but the secondary form of the 
 disease. Suppression of the menses, however, not unfre- 
 quently excites a Consumption, bearing all the characters 
 and requiring the treatment of primary Phthisis. Th« 
 plethora, consequent on the cessation of the menses, has 
 often the same effect. 
 
 Asthma, by the constant irritation to which it subjects 
 the lungs, becomes an exciting cause of Consumption. 
 
 Several eruptive diseases, as Scarlatina, Small-Pox and 
 measles, often produce the same disease. 
 
 Morton also enumerates stone in the kidneys and blad- 
 der, gout and rheumatism, as causes of Consumption. 
 
21 
 
 By the same author, contagion is supposed to commu- 
 nicate this disease. Morgagni, Van Swieten, Home and 
 Heberden all hold this opinion. And Morgagni relates 
 that Valsalva, who was predisposed to Consumption, was 
 so satisfied of its contagious nature, that he constantly 
 avoided being present at the dissection of the lungs of 
 persons who had died of that disorder. 
 
 Dr. Rush maintains the same doctrine, and relates that 
 the late Dr. Beardsley of Connecticut, informed him that 
 he had known several black slaves affected by a Consump- 
 tion, which had previously swept away several of the 
 white members of the family to which they belonged. In 
 these slaves no suspicion was entertained of the most dis- 
 tant relationship to the persons from whom they had con- 
 tracted the disease : nor had grief nor fatigue, been sup- 
 posed to have had the least share in debilitating their bo- 
 dies. The force of so much authority with the evidence 
 adduced, constrains us to admit the communicability of 
 Consumption by contagion. But if this agent has any ef- 
 fect, its action must be extremely limited, and extend no 
 farther than to those previously predisposed to the disease. 
 For daily examples without number occur of the constant 
 attendants upon those labouring under Phthisis remaining 
 perfectly free from that malady. 
 
 Violence done to the lungs by blows or other injuries 
 of the chest, has in some instances, excited Consump- 
 tion/ 
 
 f Dr. Lind states, that out of 369 patients whom he attended "between July ], 
 1758, and July 1, 1760, in consumption, the disease was Drought on one fourth of 
 
22 
 
 Foreign bodies conveyed accidentally into the lungs 
 has produced the same effect. Morton relates a curious 
 case where three nails had passed into a person's trachea 
 and destroyed him, by inducing Consumption. 
 
 Bayle also enumerates a form of Phthisis, which he 
 calls cancerous, arising inpatients in whom the cancerous 
 disposition has become constitutional. It is, however, 
 extremely rare ; only three cases having occurred to him 
 among the 900 whom he had examined. 
 
 Haemoptysis and tubercles are mentioned by most au- 
 thors as exciting causes of Consumption, and remain to 
 be examined. So frequently did Dr. Cullen consider 
 Haemoptysis the cause of Phthisis, that he placed the lat- 
 ter disease in his Nosology, merely as a consequence of 
 the former. The impropriety of this arrangement has 
 been already touched upon. 
 
 On this subject, I would suggest the following facts. 
 Haemoptysis occurring in persons not predisposed to Con- 
 sumption, except the quantity of blood lost be so great as 
 to produce it by mere debility, very frequently may be 
 easily cured without danger of any consequent disease. 
 Indeed not only in such cases consumption is not induced 
 by it, but that disease has actually been prevented, by 
 the occurrence of haemorrhage from the lungs, relieving 
 that inflammation, which like the inert physician, by with- 
 holding the lancet, would have suffered to destroy his 
 
 them by falls, bruises and strains, received a year or two before it made its ap- 
 pearance. 
 
23 
 
 patient. Dr. Rush relates two cases of inflammatory Con- 
 sumption attended by a haemorrhage of a quart of blood 
 from the lungs, in which the patient recovered ; and 
 ascribes their recovery entirely to the loss of blood. 
 Wounds and other injuries of the lungs frequently heal, 
 when no predisposition to Phthisis exists, as easily as in 
 other parts of the body. Of this fact also Dr. Rush 
 affords an example. A British officer informed him, a 
 few days after the battle of Brandy wine, in September 
 1777, that the surgeon general of the royal army had 
 assured him, that out of twenty four soldiers admitted 
 into the hospitals, during the campaign of 1?76, with 
 wounds of their lungs, twenty-three recovered. These 
 facts prove sufficiently that the constant motion of the 
 lungs does not prevent the healing process taking place in 
 them as easily as in other parts of the body. 
 
 Inmost instances, the spitting of blood which is suppo- 
 sed to have produced the Consumption, has occurred a 
 considerable period before the Phthisical symptoms ap- 
 peared. During this interval perhaps the patient was 
 perfectly well. Can it be supposed, that the inflamma- 
 tion necessary to form an ulcer, and the process of ulce- 
 ration itself, could so long be going on unperceived, with- 
 out producing any irritation of the lungs r Is it not more 
 probable, that the Haemoptysis was recovered from, and 
 that the same cause which produced it, at length produced 
 the Consumption ? 
 
 Haemoptysis, then, I would consider, as very seldom, 
 perhaps, never, being the cause of Consumption; but in 
 
24 
 
 all those cases in which it is assigned as the cause, merely 
 a symptom of the incipient stage of the disease. The 
 symptoms accompanying haemorrhage from the lungs, are 
 no other than those of incipient Phthisis. They are thus 
 accurately described by Dr. Reid. " When subsequent 
 to a sense of weight and oppression in the breast, which 
 scarcely amounts to a feeling of pain, together with cough, 
 difficult respiration, and general lassitude, a quantity of 
 blood is suddenly, and in a convulsive manner, dischar- 
 ged from the mouth, there can remain small doubt res- 
 pecting the part from which it proceeds. If the dischar- 
 ged blood be of a florid colour, and together with the 
 above symptoms, a saltish taste be perceived in the 
 mouth, and the patient become sensible of a degree of irri- 
 tation in the upper part of the trachea, the nature of the 
 affection is rendered altogether unequivocal." Every 
 symptom here enumerated, occurs in the early periods of 
 Consumption. 
 
 Nor have we any better reason for believing tubercles 
 to be an exciting cause of Phthisis. These appearances 
 are indeed very frequently found in dissections of the lungs 
 of those who have died of Consumption. Of the nine hun- 
 dred patients examined by Bayle, 624 had tuberculated 
 lungs. Tubercles were formerly considered as indurated 
 glands, and generally attributed to a scrophulous constitu- 
 tion ; but we are assured by Baillie, in his morbid Anato- 
 my, " that there is no glandular structure in the cellular 
 connecting membrane of the lungs ; and on the inside of 
 the branches of the trachea, where there are follicles, tu- 
 
25 
 
 bercles have never been seen." These tubercles are 
 roundish bodies, of a firm consistence, and frequently a 
 cartilaginous structure, but often containing decidedly 
 purulent matter. By the union of several of them, vomi- 
 cae are formed, which are only larger tubercles. May 
 not the formation of these bodies be sufficiently account- 
 ed for by the preceding inflammation, and they be con- 
 sidered therefore a consequence, rather than a cause of 
 Consumption? Dr. Rush insists that tubercles are the 
 effects, and not the cause of pulmonary Consumption ; and 
 remarks as a farther evidence of this opinion, that simi- 
 lar tumours are suddenly formed on the intestines by 
 dysentary, and on the omentum by a yellow fever. He 
 refers to cases of the former in the dissections of Sir John 
 Pringle, and one of the latter mentioned by Dr. Mackit- 
 trick, in his inaugural dissertation on the yellow fever, 
 published in Edinburgh, in the year 1776. Dr. Hosack, 
 in his Lectures on the Theory and Practice of Physic, 
 advocates the same doctrine, and enforces it, by remark- 
 ing, that similar tubercles are formed in the parenchyma 
 of the brain, the liver, and the kidneys, in which no small 
 glands have yet been detected, and where, as in the 
 lungs, there is nothing but cellular membrane and ves- 
 sels. It is his opinion, that it is an union of a number 
 of these cells in a state of congestion that constitutes 
 tubercles or vomicae — that in some instances they heal, 
 the matter is absorbed, and they remain in a scirrhous 
 state, the patient becoming perfectly restored to health : 
 
 D 
 
26 
 
 and hence the remark of Dr. Simmons, that tubercles 
 may exist without Phthisis. 
 
 These are all the principal predisposing and exciting 
 causes of Phthisis Pulmonalis. Some few others are men- 
 tioned by authors, but they are of either very doubtful 
 agency, or too rare to deserve notice. 
 
 The disease having been excited into action, produces 
 a succession of symptoms which are now to be detailed. 
 Its attack is frequently extremely insidious and slow ; at 
 other times, well marked and rapid in its progress. It is 
 to this insidious and gradual mode of attack, that Con- 
 sumption owes much of its fatal character. Before the 
 unfortunate patient suspects himself to be seriously in- 
 disposed, it but too frequently happens, that his fate is 
 sealed, and death is inevitable. This arrives in part from 
 the resemblance that Incipient Phthisis bears to a long 
 continued catarrh. It frequently is only marked in its 
 earliest periods by a slight, dry, hacking cough, trivial 
 during the day, increased at evening, and most trouble- 
 some at night; a sense of weight about the breast, and 
 some little difficulty of breathing, increased on taking 
 any unusual exercise, or ascending a height; the pulse 
 is slightly accelerated, and sometimes only so after taking 
 food: occasionally, burning hands and feet, and a slight 
 flush in the cheek are the only symptoms of fever. These 
 symptoms may be so slight as hardly to attract the 
 patient's notice ; at other times they are more severe 
 and distressing. Frequently, on any little unusual exer- 
 cise, the cough is increased, the patient feels a pain in 
 
27 
 
 the side, and expectorates a frothy mucus, and blood is 
 discharged from the lungs. This, perhaps, is the first 
 symptom which excites the alarm of the patient. Ex- 
 pectoration of blood is generally preceded by a saltish 
 taste in the mouth, and a sense of irritation at the up- 
 per part of the trachea.. It is known to come from 
 the lungs and not the stomach, by its frothy appearance 
 and admixture with mucus, while that from the stomach 
 is generally dark coloured and mixed with the food ; and 
 by being brought up by coughing and not vomiting. 
 The blood coming from the stomach too, is generally in, 
 larger quantity than that from the lungs. 
 
 In addition to these symptoms, the patient is often 
 affected by an increased sensibility of the lungs, obser- 
 vable on any exposure to cold, change of dress, or go- 
 ing from a warm to a cool apartment. There is a sense 
 of soreness in the lungs attended with a sensation of 
 stricture about the chest. Pain is felt in the side or 
 breast, and the patient lies with difficulty on the side 
 affected. The pain is frequently lancinating, and shoot- 
 ing through the breast, sometimes in the direction of the 
 mediastinum, at others, confined to one side. 
 
 As the disease advances, the symptoms of fever be- 
 come more marked. The tongue is diy, attended with 
 thirst, loss of appetite, nausea, and occasional vomiting, 
 and a desire for acids. The secretions generally are 
 checked. Perspiration is diminished, and the skin rs-hot 
 and dry. The urine is at first diminished in quantity, 
 and high coloured. The menses, in females, are either 
 
28 
 
 suppressed or very irregular. The bowels are frequent- 
 ly costive. The patient passes restless nights, and is 
 prevented sleeping by a tormenting cough, or if he 
 sleeps, is troubled with dreams. In consequence of in- 
 digestion, pain is felt in the situation of the stomach, at- 
 tended with flatulence. The patient begins to have a 
 pallid countenance, and emaciation gradually takes 
 place. 
 
 These symptoms may continue a length of time, gra- 
 dually debilitating the patient. But the expectoration 
 which at first was frothy, in small quantity, and coughed 
 up with difficulty and pain, increases, and gradually 
 passing through all the stages between mucus and pus, 
 at length becomes decidedly purulent. A new train of 
 symptoms follow. Hectic fever makes its appearance, 
 commencing with irregular cold and shivering fits, re- 
 turning frequently during the day. It soon, however, 
 assumes a decided character, and has two marked ex- 
 acerbations, the one at noon, the other at night. These 
 exacerbations begin with a sense of coldness, succeeded 
 by heat, and at night terminating in profuse perspira- 
 tion. During the chill and hot fit, the cough, pain, and 
 dyspnoea are aggravated, but relieved by the sweating. 
 The pulse before the paroxysm is accelerated and weak, 
 during its continuance quick and strong, but abates as 
 the perspiration flows. The countenance is generally 
 pale, but during the exacerbation is marked by a cir- 
 cumscribed crimson flush, which occurs mostly at noon, 
 hut may be produced by taking food or any other cause 
 
29 
 
 of excitement The profuse sweats do not occur after 
 the exacerbation at noon, but in the morning, while the 
 patient is warm in bed, with the system relaxed by 
 sleep. The perspiration is principally confined to the 
 superior parts of the body, as the neck, breast, and 
 about, the shoulders. The tongue is often very clean 
 during hectic fever, but sometimes furred. The bowels 
 are generally torpid, alternating with diarrhoea. 
 
 The disease continuing to advance, the cough and 
 dyspnsea increase, and the hectic symptoms become more 
 marked and violent. Emaciation rapidly goes on, the 
 face looks sharp and haggard, and the absorption of fat 
 makes the e}^es appear remarkably large and prominent. 
 At the same time, the teeth appear unusually white and 
 beautiful. The appetite becomes extremely irregular, 
 the pulse more accelerated and diminished in strength. 
 The mind is extremely vacillating, at one time depres- 
 sed, at another, elated with hopes of recovery. Profuse 
 diarrhoeas, alternated with obstinate torpor of the bowels, 
 exhaust the patient; the eyes assume a ghastly and 
 pearly whiteness ; the mouth becomes filled with apthous 
 eruptions ; sometimes hiccup ensues ; the patient's mind 
 becoming more and more disturbed, delirium comes on, 
 which soon terminates in death. 
 
 An assemblage of some or all these symptoms, con- 
 stitutes Phthisis Pulmonalis, differing however very ma- 
 terially in number, degree and violence in different pa- 
 tients. They are variously modified by a number of at- 
 tending circumstances, which require some attention. 
 
30 
 
 Many authors declare, that an expectoration of pus" 
 does not always attend this disease. The matter may be 
 confined in a vomica, and the patient die with the symp- 
 toms of Phthisis before it bursts. Nor does a purulent 
 expectoration necessarily indicate the existence of an 
 ulcer in the lungs. The matter may be poured out from 
 the secreting surfaces of the lungs without ulceration, 
 precisely as it comes from the adnata of the eye after 
 opthalmia, or the urethra in gonorrhoea, where no ulcer 
 is suspected. In the New-York hospital, dissections of 
 numerous patients who have died of Phthisis, sufficiently 
 prove the fact in question. 
 
 Nor does pain in the side or breast, always accompany 
 this disease. Dr. Reid remarks that many cases have 
 occurred in his practice, where no pain in any part of the 
 chest has been observed during the whole course of the 
 disorder. " I have witnessed," says Dr. Heberden, 
 " many deaths from genuine pulmonary consumption, 
 where dissection has demonstrated an entire destruction 
 of the substance of the lungs, and where through the 
 w-ioie course of the disease, neither expectoration of 
 blood, difficulty of breathing, nor pain in the side had 
 been present." On the other hand, pain in the side may- 
 occur merely as a consequence of the debilitated or irre- 
 gular action of the muscles, as in walking, and should not 
 be mistaken for a symptom of Consumption. 
 
 In the course of the disease, dropsical effusions, con- 
 stituting Ascites, Hydrothorax and Anasarca, are not 
 
31 
 
 unusual, as in other diseases where great debility is pro- 
 duced. 
 
 In the advanced periods of Consumption, diarrhoea 
 constitutes a prominent and troublesome symptom. This 
 is sometimes produced by any cause which checks the 
 profuse sweats; while on the other hand, if the diarrhoea 
 be checked, the cough and dyspnoea, which perhaps had 
 been relieved by it, frequently return with redoubled 
 violence. Under these circumstances, the condition of 
 the patient is hopeless indeed. 
 
 The approach of summer frequently mitigates the 
 sufferings of the consumptive, and gives them hopes of 
 returning health; but when winter returns, these hapes 
 are blasted ; the patient sinks again into his former 
 condition, and most generally is cut off during the cold 
 season. 
 
 The symptoms of Phthisis are frequently suspended 
 or mitigated by any cause producing a new determination 
 in the system. The most prominent of these causes is 
 pregnancy. It almost invariably happens that the symp- 
 toms of Consumption are relieved by the occurrence of 
 this event ; but after parturition the disease returns with 
 all its former violence. The occurrence of mania has 
 produced the same effect, and has even entirely cured 
 the disease ; but generally, when the mania is removed, 
 the symptoms of Consumption return. An attack of 
 rheumatism has frequently relieved phthisical complaints. 
 Dr. Rush refers to three clinical patients in the hospital of 
 Pennsylvania to exemplify this observation. In the same 
 
32 
 
 maimer gout is observed to alternate with Consumption, 
 and during its paroxysms, the complaint of the lungs is 
 relieved. Frequent cases are related, in works on this 
 subject, of eruptions on the skin alternating with Phthisis 
 Pulmonalis. 
 
 Long continued ulcers, or fistulas in ano not unfre- 
 quently relieve pulmonic complaints in phthisical patients ; 
 while the healing of these ulcers or fistulas reproduces the 
 disease with tenfold violence. 
 
 A farther circumstance worthy of remark in this dis- 
 ease is, the willingness with which the patient suffers 
 himself to be flattered with hopes of recovery. Notwith- 
 standing he sees daily victims of Consumption falling 
 around him ; notwithstanding the perfect assurance he 
 has of the small number of those who recover from it ; 
 to the last his hopes are not abandoned. Although de- 
 pressed at night by the evening exacerbation of hectic fe- 
 ver; in the morning, from his comparatively comfortable 
 situation, his hopes revive. Happy is it for these misera- 
 ble sufferers that they do not despair. In a disease whose 
 progress is frequently so slow, and whose event is but too 
 often so sure, fortunate it is, that a solace remains to cheer 
 the unhappy patient. 
 
 The duration of Consumption is extremely various ; 
 from a few weeks to fifty years have patients laboured 
 under it. In Bayle's statement of the duration of the 
 disease in two hundred cases in which the patients were 
 destroyed by it, it was between two months and two years 
 
33 
 
 in 168 cases, four were less than two months, and 2S re- 
 mained more than two years. 
 
 From the detail of symptoms which has just been 
 given, it is evident, that there are two distinct stages of 
 Phthisis Pulmonalis, each characterised by peculiar symp- 
 toms, and requiring peculiar treatment. The first, inci- 
 pient, or acute stage as it is variously termed by au- 
 thors, is the stage of inflammation, and terminates as 
 soon as purulent expectoration and hectic fever com- 
 mence. The second, confirmed, or chronic stage com- 
 mences where the first terminates, and ends most gen- 
 erally in death. We would not however assert, that 
 these stages can always be accurately distinguished, and 
 a line drawn between them. On the contrary, hectic 
 fever may occur early in the disease, before any expec- 
 toration of pus takes place, and inflammatory symptoms 
 frequently attend its advanced stage. In general, the 
 -distinction can be made, and must necessarily guide the 
 prudent physician. 
 
 Having taken a view of the causes and symptoms of 
 Phthisis Pulmonalis, w^e are now prepared to investi- 
 gate the proximate cause of the disease. From the na- 
 ture and extent of these symptoms, it appears evident- 
 ly a disease of the whole system, and not confined 
 merely to the lungs. The proximate cause, as taught 
 by Dr. Hosack, in his lectures, is, an inflammation of 
 the lungs, terminating either in a purulent secretion, or 
 ulceration in their substance. This opinion is much 
 
 strengthened bv the analogy before remarked between 
 
 E 
 
34 
 
 Phthisis Pulmonalis and Pneumonia. It is a little 6hv 
 gular that Dr. Rush, notwithstanding he had remarked 
 this close analogy, and although he speaks of inflam- 
 matory fever as a part of the disease, and prescribes 
 blood-letting in its treatment, should yet have made de- 
 bility its proximate cause. This is only one instance 
 among many, of physicians arriving at precisely the same 
 modes of treatment by directly opposite routes. If that 
 theory of inflammation be admitted, which makes de- 
 bility its cause, so far it is also the proximate cause of 
 Phthisis Pulmonalis. In the secondary species of Phthisis, 
 hereafter to be considered, debility may be fairly ranked 
 as the proximate cause, and the indications of cure cor- 
 rectly drawn from it. But in the primary disease under 
 consideration, if we were to found our indications on 
 this basis, and thence deduce the propriety of exhibiting 
 powerful tonics in the first stage of the disease, when 
 brought to the test of practice, its error would soon be- 
 come sufficiently glaring, 
 
 Various other causes have been successively treated of 
 by authors, but to shew their inconsistency and absurdi- 
 ty, it is only necessary to observe that, " the existence 
 of an acid or an alkali, of chemical acrimony, or mecha- 
 nical changes in the blood, of corroding volatile parti- 
 cles, and even of animalcula in the lungs, have been 
 vaguely conjectured to be the cause of pulmonary ulcer 
 and hectic fever.s" 
 
 8 Dr. Reid. 
 
35 
 
 Assuming then, inflammation of the lungs, and con- 
 sequent ulceration of their substance as the proximate 
 cause of Phthisis Pulmonalis, we naturally deduce the 
 following indications in the treatment of the disease. 
 
 1. To endeavour to relieve the inflammation of the 
 lungs, and promote its resolution. 
 
 2. If, notwithstanding all our efforts, suppuration 
 takes place, to give sufficient support and tone to the sys- 
 tem to enable the ulcers to heal. 
 
 In fulfilling these indications, our first object is to re- 
 move the remote causes, where it is possible. If the pa- 
 tient's occupation is one of those which predisposes to 
 Consumption, unless it be abandoned, or at least so mo- 
 dified as to correct the objectionable parts of it, we can- 
 not hope to cure the disease. If the disease arise from 
 the suppression of an accustomed evacuation, our ut- 
 most endeavours must be made to restore it. Should 
 suppression of the menses be the cause, means calculated 
 to produce their return must be resorted to. If an ulcer 
 or fistula has healed up, they must be re-opened, or is- 
 sues established in more convenient situations. In short, 
 the rule is plain and simple. Remove the remote cau- 
 ses, wherever it is practicable. 
 
 Among the remedies which are necessary to fulfil 
 the first indication, the most prominent is Blood-letting, 
 This remedy has been strongly advocated by many of 
 the most distinguished authors who have written on 
 Consumption; and its propriety admitted by all under 
 certain circumstances, Probably, most of the injurious 
 
36 
 
 effects attributed to it, may be accounted for by a proper 
 distinction not having been made between Primary and 
 Secondary Phthisis Pulmonalis. When bleeding has been 
 practised in the secondary form of the disease, it has been 
 generally injurious, and hence an odium has been cast 
 upon its employment in any circumstances. In the same 
 manner, it has done mischief, when used too late in 
 Primary Phthisis, and thus another groundless argument 
 furnished against the remedy. But the indiscriminate 
 use of blood-letting is not here contended for. Its ju- 
 dicious and cautious use, when inflammatory action is 
 evident, alone is intended to be advocated. On the other 
 hand, too timid practice may induce u& to withhold the 
 lancet when it is necessary ; and we may thus do as 
 much injury by losing the proper time for action, a& 
 we would have done by pushing the remedy too far. 
 It is dim cult to fix the period beyond which it is im- 
 proper to bleed in Consumption, Dr. Hosack insists 
 that as long as there is any pain or soreness on taking a 
 full inspiration, the lancet is necessary. This rule is not 
 applicable to practice ; for if we adopt it, we may bleed 
 the patient until he dies. Until that moment will the 
 pain in some instances continue. It is not unfrequent,. 
 after the patient has been exhausted by colliquative 
 sweats, and profuse diarrhoea, for pain in the breast to 
 recur at intervals, a few days before death: and what 
 practitioner, under such circumstances, would feel him- 
 self justified in using the lancet? But this rule is incor- 
 rect in another point of view. In some cases, it will 
 
37 
 
 prevent our using this valuable remedy, when it is ne~ 
 eessary. On the authority of Dr. Reid, it is asserted, 
 that pain is not always present in Phthisis Pulmonalis ; 
 and may not occur during the whole course of the dis- 
 ease. A reference has been already made to Dr. Heber- 
 den to prove the same fact. On this subject it is impos- 
 sible to fix any precise rule; The strength and habit 
 of the patient, the urgency of the symptoms, and state of 
 the pulse, must all be recollected and adverted to in ma- 
 king up our judgment as to the propriety of the remedy. 
 In general, perhaps we may say, that after the formation 
 of matter is perfectly ascertained, it is improper to bleed. 
 This, however, is not without exceptions. Cases some- 
 times occur, after this period, in which the symptoms 
 of high inflammatory action arise, and where the lancet 
 is indicated. It is now generally admitted that the buffy 
 appearance of the blood is by no means an infallible evi- 
 dence of the necessity of the repetition of blood-letting. 
 Nor is its cupped form a better proof of the existence 
 of inflammation. Many writers have observed, that 
 the burly coat appears- in the blood drawn in Consump- 
 tion at the latest periods of the disease. A remarkable 
 and decided case of Enteritis, occurred during the last 
 winter, in the New- York Hospital, in which very large 
 and repeated bleedings were made use of, with the good 
 effect of curing the patient : and yet, neither buff nor 
 the cuplike form appeared in the smallest degree in the 
 blood drawn. This case alone is sufficient to prove, 
 how equivocal are these appearances of the bloody as 
 
33 
 
 tests of inflammation. Nevertheless, the judicious prac- 
 titioner will not fail to observe these circumstances, and 
 as they so frequently accompany inflammation, will con- 
 sider them, when attended with other evidences, as 
 properly influencing his judgment on the propriety of 
 bleeding. 
 
 If the abstraction of blood from the system generally 
 is useful, no less so is it when drawn from the part 
 itself, by the application of cupping-glasses, and the 
 scarificator to the chest. This mode of obtaining blood 
 is peculiarly useful in those frequent cases, where the 
 patient is too much debilitated to bear the loss of much 
 blood, but the existence of inflammatory action makes its 
 abstraction necessary. 
 
 Emetics are a powerful remedy in the treatment of 
 Phthisis. They not only promote expectoration, and re- 
 lieve the distressing cough in the first stage of the disease, 
 but by their general relaxing effects upon the system, 
 are useful in reducing inflammatory action. The use 
 of this remedy, however, should not in general be com- 
 menced until blood-letting has been premised ; other- 
 wise in plethoric habits, full vomiting might induce 
 haemoptysis. Practitioners have differed very much in 
 the choice of emetics proper in this disease. The an- 
 timonial preparations and ipecacuanha, as acting more 
 generally upon the system in reducing excitement, and 
 from their good effects in other febrile diseases, appear 
 to be the most proper. But in t l ^e last stage of Con- 
 sumption, where our object is to relieve the pulmon- 
 
33 
 
 aty symptoms, without debilitating the patient, the 
 sulphates of zinc and copper are preferable. 
 
 Emetics are not only useful when exhibited for the 
 purpose of full vomiting, but medicines of the same 
 class given as diaphorectics are also proper. With this 
 view the various preparations of antimony are in use. 
 Small doses of the Antimonial powder combined with 
 calomel have been found, perhaps, one of the best su- 
 dorifics that can be employed, and as such are frequently 
 useful in Phthisis. No medicine is superior to this 
 combination in reducing inflammatory action ; and ii 
 frequently has a better effect by proving both emetic 
 and purgative. 
 
 As a sudorific, warm bathing may be very useful, and 
 is an agreeable remedy in the inflammatory stage of 
 Phthisis. As the warm bath is useful in relaxing the 
 surface of the body generally ; in a similar manner in- 
 haling warm air, by means of Mudge's apparatus, re- 
 laxes the inflamed membrane of the bronchiae, and 
 acts as a fomentation there, with the same good effect 
 as is produced by warmth and moisture upon any other 
 inflamed surface of the body. This remedy gives great 
 relief in the cough and hoarseness so distressing in Phthisis 
 Pulmonalis. 
 
 With the same view of counteracting inflammation- 
 cathartics may be prescribed. As in other febrile dis- 
 eases, so in Phthisis, the bowels are frequently torpid, 
 and require the frequent use of aperient medicines. Sa- 
 line and mercurial cathartics, possessing the greatest 
 
40 
 
 power in diminishing excitement, are perhaps the most 
 proper in this disease. But as it is an object not to in- 
 duce too much debility, the use of drastic purgatives 
 should be avoided as much as possible, and be confined 
 to the earliest periods of the disease. During its ad- 
 vanced stage, the bowels should be kept open by mild 
 laxatives and enemata, which tend least to debilitate the 
 patient. 
 
 Blisters, Setons and Issues relieve the inflammation of 
 the lungs, and produce a new determination to- the sur- 
 face with the happiest effects. Most writers agree in 
 recommending repeated blisters to the chest, as an useful 
 remedy, and with reason. But it is to be regretted that 
 they have been suffered to usurp the place of a more 
 powerful remedy of the same class, viz. Issues. If we 
 may judge from; the effect of ulcers and fistulas, which 
 palliate all the symptoms of confirmed Phthisis, while 
 they continue, but whose healing restores the disease, it 
 would appear that the establishment of similar drains, in 
 the form of issues, ought to have a good effect. In ca- 
 ries of the spine, and disease of the hip joint, where 
 the inflammation in the cellular structure of the bones 
 seems to be very analagous to that in the cells of the 
 lungs, issues are used with the greatest benefit. In these 
 cases, they are uniformly preferred to repeated blister- 
 ing, and experience has sanctioned the preference. Issues 
 are preferable to blisters by their constant and uniform 
 action, whereas the latter remedy has its effect continu- 
 ally interrupted by healing up and requiring renewal. 
 
41 
 
 fn general, blisters appear to be more useful in acute dis«* 
 eases, which may soon be subdued : but in Phthisis 
 Pulmonaiis, which continues so long, and whose pro- 
 gress is so slow, issues appear to be the better remedy, 
 Dr. Mudge was so well convinced of their efficacy, that 
 he assures us, he cured himself of an Incipient Con- 
 sumption, by a large issue between the shoulders. Bed- 
 does also recommends them, and relates several cases, 
 in which they were used with the best effect. But if 
 this remedy be tried, it should not be done timidly, and 
 with the fear of giving pain ; when used at all, issues 
 should be large and effectual, not only sufficient to con- 
 tain a single pea, but at least a dozen. This is not the 
 only remedy which has fallen into disrepute by a trifling 
 and inefficient mode of employing it. But as blisters are 
 preferred by many of the most judicious practitioners, 
 their use may easily and with advantage be combined 
 with that of issues. While a large issue is kept open 
 between the shoulders, successive blisters may be ap- 
 plied to the chest. Many patients, perhaps, would not 
 submit to so severe a mode of treatment ; but it is only 
 by such active and efficient practice, that we can hope to 
 cure this formidable malady. 
 
 It is only in the first stage of Consumption that much 
 benefit is to be expected from this class of remedies, 
 or at all events, before the patient is much debilitated. 
 In its latest periods, they would tend rather to add to 
 the debility already induced by the disease. Af 
 
42 
 
 any time, however, when the patient is not too much 
 reduced, they may be prescribed with advantage. 
 
 Mercury, given until it produce salivation has fre- 
 quently cured Phthisis Pulmonalis. It is used with 
 greatest advantage in its first stage, but after the in- 
 flammatory action has been in some measure reduced, 
 by means of blood-letting, and the other remedies pro- 
 posed. Before these evacuations have been premised, 
 it would tend rather to increase the inflammation ; while 
 in the advanced stage it would add too much to the 
 debility of the patient. It generally succeeds only when 
 it affects the mouth, and therefore to secure this effect 
 and prevent its running off by the bowels, it should be 
 combined with opium. But the best form of exhibiting 
 mercury, is one much in use with my worthy friend and 
 preceptor, Dr. Borrowe. Calomel, combined with small 
 doses of antimonial powder, given morning and evening, 
 until it affect the mouth, is the form proposed. In this 
 way it may be given at an earlier period of the disease, 
 than would otherwise be proper, by the constant deter- 
 mination to the skin kept up by the antimonial powder, 
 obviating the tendency which mercury has to increase 
 inflammatory action. At the same time it serves to keep 
 the bowels open, and makes almost every other medicine 
 unnecessary. On the other hand, if it acts too much on 
 the bowels, it may be usefully combined with opium , 
 which adds to its diaphoretic effect. The good effects of 
 this mode of exhibiting mercury, is strikingly illustrated 
 by the result of the following case, which occurred in 
 
43 
 
 "the practice of Dr. Borrowe within a few months 
 past. 
 
 "Miss -^— , aged about 14 years, had been for six 
 
 months past, afflicted with some cough, pain in the 
 chest and difficulty of breathing. She was affected with 
 loss of appetite, emaciation and profuse sweats at night. 
 Her pulses were frequent; she had the peculiar pearl- 
 like appearance of the adnata; frequent attacks of di- 
 arrhcea, and an expectoration much resembling pus. 
 She was attacked with chills about the middle of the 
 day, followed by considerable excitement, aversion to 
 motion and drowsiness ; succeeded by great prostration 
 of strength ; palpitation and hurried breathing on ascend- 
 ing a height or engaging in any considerable bodily 
 exertion ; attended with a livid appearance of the lips, 
 evidencing a difficulty in the passage of blood through 
 the lungs. 
 
 It was determined to put her upon the use of Calomel 
 and Pulv: Jacob: which were given in small doses every 
 night and morning ; a blistering plaister was also applied 
 to the chest, and kept in an irritable state for a considera- 
 ble length of time. The diet was ordered to be soft, 
 mild and nutritious. The mercury and antimonial 
 medicine were occasionally omitted when they acted more 
 on the bowels than the skin, or occasional anodynes were 
 administered to restrain their action on the alimentary 
 canal. 
 
 Some weeks elapsed before the mercury produced any 
 effect upon the salivary glands, w r hich was one of the ob- 
 
44 
 
 jects aimed at. As soon as the mouth became sensibly 
 aiiected, the symptoms were generally mitigated. A tem- 
 porary suspension of the use of the remedies became ne- 
 cessary, iu consequence of the considerable effect produ- 
 ced by the mercury. When the soreness of the mouth 
 abated, small and less frequent doses of the calomel were 
 given so as to keep up a tenderness of the gums several 
 weeks longer. The affection of the chest became now en- 
 tirely relieved, and it was thought advisable to suspend 
 the use of the mercurial treatment, the effects of which 
 were suffered to pass off, rather than be relieved or 
 cured. 
 
 From this time no medicines were employed, except a 
 small quantity of a weak infusion of Colombo as a tonic. 
 Long before the patient's mouth enabled her to eat, her 
 appetite became craving. She was indulged in eating 
 moderately of such food as she had a particular desire 
 for; and she soon was enabled to take exercise without 
 inconvenience. She did not now complain of any pain 
 in the chest, the cough left her, the bowels became re- 
 gular, there was no recurrence of night sweats, she began 
 to gain flesh, the countenance assumed the healthy as- 
 pect, and the peevishness under which she had long la- 
 boured was effectually cured, She now slept well, and 
 gradually returning to her former habits, is at the end of 
 five months after discontinuing her remedies, in perfect 
 health." 
 
 Digitalis is a remedy in Phthisis, which has excited 
 much acrimonious controversy among practitioners of 
 
medicine. As always happens in these contests, it bas 
 been praised too highly by one party, and condemned too 
 severely by the other. When first introduced, it seemed 
 to promise the complete eradication of Consumption ; 
 and it almost appeared that digitalis was as specific in 
 the cure of that disease, as mercury, in syphilis. Dr. 
 Magennis of the Royal Xavy Hospital at Plymouth, 
 England, published a paper, containing an account of se- 
 venty-two cases of incipient or confirmed Consumption, in 
 seamen and marines, treated with digitalis. Of these, 
 twenty-five with ulcerated lungs recovered; and fifteen 
 from the stage previous to ulceration. Thirteen of the 
 seventy-two in an early stage of ulceration were dis-- 
 charged, greatly relieved ; and nine in the previous stage. 
 In ten cases, the medicine failed ; but in some of these it 
 gave considerable relief. Beddoes assures us, that three 
 cases out of five of tubercular consumption, in his prac- 
 tice, had recovered under the use of digitalis. Kinglake 
 insists that one in three cases of the tubercular stage of 
 Consumption, may be cured by this medicine. Dr. Cur- 
 rie informs us, that digitalis may be used with safety and 
 success in cases where the lancet can no longer be em- 
 ployed. These results in the practice of men, distinguish- 
 ed in their profession, although they may be somewhat 
 -warped by prejudice, are extremely flattering, and prove 
 at least that the medicine has some power. But like all 
 other new remedies, digitalis has been rated too highly 
 by those who first used it. Delighted that they had dis- 
 covered a medicine, which, in some cases would cure a 
 
46 
 
 disease, which they had been accustomed to look upon as 
 totally incurable, these physicians have suffered them- 
 selves to attend too exclusively to its successful results, 
 and to neglect cases in which it has failed. Other prac- 
 titioners, on reading their exaggerated statements, have 
 tried the remedy, but finding themselves frequently dis- 
 appointed, have gone into the other extreme and con- 
 demned it entirely. Their representations are to be ad- 
 mitted with as much qualification as those of their op- 
 ponents, and the judicious physician will not suffer him- 
 self to be exclusively guided by either. That in certain 
 cases, digitalis will cure Consumption, cannot be doubted ; 
 but we have also to regret, that it very frequently fails. 
 It was prescribed in the New-York Hospital, under 
 the direction of Dr. Hamersley, during the last winter, 
 in six cases which I have witnessed, of evident and well 
 marked Phthisis. Of these, two patients were perfectly 
 cured; one has nearly recovered, and is only retained in 
 the Hospital for a slight cough, which is yielding ; a fourth 
 was discharged at his own request, but evidently re- 
 lieved ; the fifth commenced the use of digitalis, at a 
 very advanced period of the disease, and soon died; in 
 the last it failed entirely, and appeared rather to have 
 done injury. 
 
 Having ascertained that digitalis does sometimes suc- 
 ceed in curing Phthisis Pulmonalis, it remains to discover 
 what are the cases in which we may exhibit it with success. 
 For this purpose it would be desirable to ascertain the 
 modus operandi of the medicine. Here writers have differ- 
 
47 
 
 ed as widely as in their account of its success in practice. 
 One author determines it to act by diminishing the force 
 and frequency of the circulation, and reducing inflamma- 
 tory action ; a second attributes its salutary effect to its 
 operation on the kidneys; while a third believes it no 
 longer to be of advantage,when it increases the discharge by 
 urine, excites nausea, vomiting, purging or any undue ex- 
 citement, but attributes its beneficial effects to its stimu- 
 lant efficiency, in invigorating the arterial and muscular 
 energy of the system: and a fourth insists that by promo- 
 ting the action of the absorbents it cures Consumption. 
 These conflicting and opposite opinions constrain us to 
 admit, that farther enquiry is necessary, before we can 
 rest satisfied as to the mode in which digitalis acts. It 
 must be confessed that this medicine is extremely uncer- 
 tain in its operation. Its most evident effect, and that 
 most insisted on, of reducing the frequency of the pulse, is 
 by no means certain; and indeed, it is the opinion of Dr. 
 Beddoes, that the force and strength of the pulse are 
 increased by it. In the N. Y. Hospital I have witnessed 
 frequent cases in which it s continued exhibition produced 
 no effect in reducing either the force or frequency of the 
 pulse ; and in some inst ances no effect at all seemed to 
 be produced by it. A case occurred in that institution in 
 October last, in which a patient, by his own carelessness 
 took six drachms of Tinct: Digitalis with no evident injury. 
 In examining the effect of this medicine on the pulse, it 
 is necessary to recollect the remark of Beddoes, that it is 
 verv different in the recumbent and erect posture; 
 
48 
 
 the pulse frequently being found to be reduced m 
 frequency and irregular in the former, but recovering 
 its frequency and regularity in the latter situation. 
 From the same author we learn, that if this remedy do not 
 produce any good effect witnin three weeks, we can ex- 
 pect no advantage from it at all. It is generally admitted 
 that digitalis will succeed only in the first stage of 
 Phthisis Pulmonalis; in the last or ulcerated stage of that 
 malady, it will not save our patient, but we are apprehen- 
 sive, will rather hasten his dissolution. As it is ack no wledg- 
 ed to be an uncertain medicine, we should not place our 
 whole dependence upon it, nor suffer it to take the place 
 of blood-letting and the rest of the antiphlogistic treat- 
 ment before recommended : it should be used rather as 
 an auxiliary than a principal remedy. From it3 uncertainty 
 of operation it requires a cautious exhibition. The dose 
 for an adult is from ten to fifteen drops of the saturated 
 tincture, three times a day, and gradually increased until 
 some effect is produced. 
 
 The use of factitious airs in Consumption is now very 
 much abandoned. No essential benefit has ultimately 
 appeared to be derived from them; although in the 
 first instance, they produced some apparently good 
 effect. 
 
 Of much more advantage is a sea-voyage and a mild 
 climate. The benefit evidently derived from sea-voyage* 
 has been attributed to various causes. The nausea and 
 vomiting from sea-sickness, the uniform motion and srentle 
 regular exercise produced by sailing, and the uniformity 
 
49 
 
 and mildness of the atmosphere of the ocean, so evident 
 at a distance from the land, probably all combine in pro- 
 ducing these happy results. We can hardly suppose, 
 however, with Dr. Mudge, that the exhalations from the 
 tar and pitch about the ship, taken into the lungs in 
 respiration, have any agency in the effect produced. But 
 whatever be the cause, it is not at all unfrequent for 
 consumptive patients to experience immediate relief 
 after having been a few days at sea. A sea-voyage to 
 produce permanent benefit, should be long continued, 
 and what is of still more importance, terminate in a 
 mild climate. Every winter, instances occur in this 
 city, of consumptive patients being restored to health 
 by a voyage to the south of France, or some other 
 country of similar temperature. The climate most 
 grateful to these patients is one whose temperature is 
 uniform, not subject to any sudden variations, and where 
 the atmosphere is dry and pure. The island of Ma- 
 deira possesses all these requisites. The part of it best 
 adapted to the purpose in question is thus described by 
 Dr. Adams, a physician of that island, in a letter to hie 
 friend in London : — 
 
 " The valley of Funchall is defended by immense hills 
 from every wind but the south, where it is open to the 
 sea-breeze; this preserves a temperature so even, as is 
 unknown in any other part of the world. Our winters 
 may be compared to your summers in every thing but 
 the length of days, and those sudden changes from 
 heat to cold, to which you are subject- The thermome- 
 
50 
 
 ter with us is often steady within doors, or vanes scarcely 
 a degree for weeks together. During winter its whole 
 range is from 58 to 65 ; and in summer, from 70 to 75* 
 rarely amounting to 80 ; the heat being always tempered 
 by a breeze in proportion to the force of the sun. The 
 dryness of our atmosphere is not less remarkable." 
 
 If this description be correct, Madeira has a climate 
 possessing every requisite to make it most favourable to 
 phthisical patients. The southern parts of the United 
 States are frequently resorted to, also, by the consump- 
 tive with great benefit. I have had the satisfaction of 
 seeing a young friend return from Charleston, a short 
 time since, perfectly restored to health, who, during the 
 last autumn, was attacked with repeated haemoptysis 
 and other symptoms of Incipient Phthisis. 
 
 It is to be regretted, that change of climate, a remedy 
 of so much advantage in the early stage of Consumption, 
 should so often be postponed, until no possibility of 
 recovery remains. It is too often the fate of such pa- 
 tients, to leave their homes in quest of health, merely to 
 find a foreign grave; resorting to that remedy which 
 should have been first, as the last effort of despair. To 
 this cause alone, may we attribute its frequent inefficiency, 
 and unfortunately the same cause has contributed too much 
 to bring the remedy into disrepute* 
 
 Where from any circumstances, change of climate is 
 impracticable, it may to some extent be imitated, by con= 
 fining the patient to apartments whose temperature is kept 
 constant and uniform, This has been tried and with some 
 
51 
 
 success ; and is probably, the remedy of the same class, 
 next in power, but much inferior to a warm climate. 
 Beddoes made use of it in several cases with relief to his 
 patients, but it has not yet been sufficiently tested to 
 establish its character as a remedy in Phthisis Pul- 
 monalis. 
 
 Besides the use of the remedies which have been 
 enumerated, with the view of effecting a radical cure of 
 this disease, there are some symptoms occurring in its 
 first stage, which require immediate relief. Haemoptysis 
 sometimes comes on in such a manner as to be very 
 alarming to the patient. Blood-letting in large quantities, 
 and repeated in proportion to the strength and habit of 
 the patient and violence of the symptoms, is then ab^ 
 solutely necessary. Unless the plethora, which is oppres- 
 sing the system, and exciting the haemorrhage from the 
 lungs, be relieved by general blood-letting, blood will not 
 cease to pour out from that viscus. At the same time 
 the free exhibition of saline cathartics, a blister to the 
 chest, a rigidly abstemious diet and a strict adherence 
 to the antiphlogistic regimen must accompany this 
 treatment. Peruvian Bark, Chalybeates and Elixir of 
 Vitriol so often used, in active haemorrhage during the 
 inflammatory stage of Consumption cannot but be 
 injurious. They increase the force of the circulation 
 and consequently the disposition to haemorrhage. In 
 the same symptom arising from an opposite cause, they 
 may be prescribed with advantage. Common salt, 
 administered dry in the manner directed by Dr. Rush ? 
 
52 
 
 has been found by experience to be very useful in abating 
 haemorrhage from either cause; but it should not be 
 depended on alone, nor suffered to take the place of the 
 treatment just detailed. 
 
 If possible, we should anticipate the occurrence of 
 haemoptysis with our remedies, and thus prevent the 
 formation of a habit of spitting blood, which when once 
 established, is difficult to destroy. The usual precursors 
 of this symptom are, a saltish taste in the mouth, a sense 
 of irritation at the upper part of the trachea, and some 
 oppression and difficulty of breathing. At this time, 
 before the haemorrhage has commenced, blood-letting 
 and the rest of the remedies mentioned above should be 
 actively exhibited. " Venienti occurrite morbo" 
 
 A distressing cough at this period also requires the at- 
 tention of the physician. From its occurrence more par- 
 ticularly at night, it disturbs the rest and adds much to the 
 sufferings of the patient. It should be alleviated by 
 Opiates, accompanied with any of the mild demulcent rem- 
 edies, generally denominated Pectorals. Mudge's Appa- 
 ratus for inhaling the steam of warm water, may also be 
 used with relief, especially on going to bed. 
 
 When all inflammation is gone and the second stage of 
 Consumption has decidedly formed, a different mode of 
 treatment becomes necessary. Little indeed is now to be 
 hoped for from any treatment, as a radical cure ; but our 
 patient is not to be abandoned; if he cannot be cured, his 
 sufferings may be materially mitigated, and he may be di- 
 rected to avoid such things as may increase his malady. 
 
33 
 
 Nor should we entirely despair of performing a radical 
 cure ; ior solitary cases are related by many authors of 
 consumptive patients being cured in every stage of the 
 disease. Many of these cases, perhaps, have been mistaken 
 for Phthisis Pulmonalis ; but of some of them we cannot 
 doubt. The authority from which they come is too 
 high to permit us to hesitate. 
 
 The remedies last mentioned in the treatment of the 
 first stage of Consumption may yet be proper, and although 
 with not so great a prospect of success, should still be tried. 
 These are a sea-voyage, change of climate, and confine- 
 ment to apartments whose temperature is regulated. But 
 all the debilitating remedies before recommended, are now 
 to be avoided. The lancet in general is improper, although 
 in some few instances, the occurrence of acute inflammation 
 at this period, still requires its cautious use. Drastic Ca- 
 thartics should not be used ; the bowels if torpid must be 
 kept open by gentle laxatives and Enemata. Antimo- 
 nial and other debilitating Emetics should not now be ex- 
 hibited, but the Vitriol Emetics may still be prescribed 
 with advantage. The Sulphate of Zinc given in such do- 
 ses as to excite occasional vomiting, is frequently very use- 
 fill, and especially where much irritation is present. It 
 was introduced and strongly recommended by Dr. Mosely 
 in his Treatise on Tropical Diseases &c. His Vitriolic so- 
 lution 11 is certainly an useful remedy in relieving dyspnoea 
 
 h $. Vitriol : alb : 5 iij 
 
 Aium : rup ; 3 j 
 
 Coccirmel : puiv : griij 
 
 Aq: fervent: $33. Misce in mortareo marmoreo. So- 
 hitio a fseculantia vel residendo espurgetur, vei per chartam bi- 
 bulam filtretur. Dos. §ssi— ■ 
 
and promoting expectoration. Instead of debilitating c v 
 antimoniais do, he assures us, that its emetic effects are in- 
 stantaneous, not harassing the patient, but always leav- 
 ing the stomach strongly invigorated. Mr. Warburton, 
 the present House Physician of the New- York Hospital, 
 has assured me, that he has frequenty prescribed it in thai 
 Institution w T ith evident benefit. With similar intentions, 
 Dr. Senter, in the Medical and Chirurgical Review, pub- 
 lished in 1795, recommends the sulphate of copper. 
 
 At this time blisters will be preferable to either setons 
 or issues, as they relieve the local symptoms without 
 producing a constant debilitating discharge. Indeed 
 they should be used in such a manner, as to produce as 
 little discharge as possible. With this view, they should 
 not be kept open by stimulating dressings, but be healed 
 up, and occasionally renew~ed. With the same intention, 
 stimulating plaisters may be applied to the chest with 
 advantage, and in general are preferable to blisters. 
 
 To support the patient's strength, as was proposed in 
 the second indication, tonics are necessary. Of these 
 some of the simple bitters are preferable, as columbo, 
 gentian, boneset, chamomile, &c. But we should be 
 careful not to exhibit them during the paroxysms of 
 hectic fever, but during its intervals. Peruvian bark 
 has not been found admissible. It produces a sense of 
 stricture and oppression of breathing, adds to the cough, 
 makes the pulse quick and hard, and haemoptysis is not 
 unfrequently the consequence of its exhibition. Dr, 
 
Fothergill dwells particularly on the abuse of this medr= 
 tine in Consumption. 
 
 As stimulating and bitter medicines, the Poiygala 
 Seneka and Aristolochia Serpentaria have been recom- 
 mended in this stage of Phthisis Pulmonalis. 
 
 The stimulating balsams and gums are also proper in 
 this stage. They have been highly recommended by 
 Morton ; and myrrh in particular is prescribed with great 
 confidence by Simmons. They are objected to by .Fo- 
 thergill, on the ground, that by their stimulating pro- 
 perties, they increase the inflammation of the lungs. His 
 objection appears well founded, while symptoms of acute 
 inflammation still exist; but after they have subsided, 
 the cough and other distressing symptoms of the last 
 stage of Phthisis, may be much alleviated by these medi- 
 cines. By their stimulating effects upon the whole 
 system, also, they may be useful at a time when the pa- 
 tient is sinking under great debility. 
 
 As stimulating applications are frequently found ne- 
 cessary and useful to indolent ulcers on the surface of the 
 body, it naturally occurred that similar applications 
 might be made with advantage to ulcers of the lungs. 
 With this view, the steam of tar water, and the vapour 
 of sulphuric aether inhaled in respiration, have been used 
 in the treatment of Consumption. 1 With the same re- 
 
 i Dr. Borrowe formerly had a patient labouring under Consumption, a manu- 
 facturer of tin ware, who was uniformly relieved of his phthisical symptoms 
 when engaged in soldering tin, a process in which a great deal of resin is used, 
 and constantly inhaled in respiration. 
 
Ob 
 
 sfcrictions as are necessary with the stimulating gums 
 and balsams, these remedies may be beneficial. It is not 
 probable, however, that any permanent relief can be 
 derived from them ; they can only mitigate symptoms. 
 
 To check the profuse sweats, which occur at this pe- 
 riod, and add materially to the debility of the patient, the 
 elixir of vitriol is an useful medicine. As a general to- 
 nic it acts beneficially also upon the whole system. 
 
 With the view of quietting the cough and procuring 
 rest at night, opiates are necessary ; and fortunate are we 
 that we have in our possession, a remedy, which although 
 it will not permanently cure the disease, palliates the 
 symptoms, at least for a time ; and makes more smooth 
 the path to death. It is true that opium produces some 
 ill effects. It debilitates the stomach, and injures the 
 appetite ; but when the S3'mptoms are urgent, it cannot 
 for those reasons be dispensed with. By lulling pain, 
 and giving rest to the watchful patient, it more than 
 counterbalances these disadvantages. The humulus lu- 
 pulus or common hops, does not possess the objection- 
 able properties of opium, but with its anodyne combines 
 some tonic powers, and promises to be an excellent sub- 
 stitute for that medicine. 
 
 The large and frequent use of syrups in the form of ex- 
 pectorant mixtures and linctuses, to alleviate cough, is 
 very injurious. They cloy the appetite, destroy the tone 
 of the stomach, and prevent the taking of nutritious ali- 
 ment, which is now so necessary ; and frequently without 
 producing any material relief of the symptom for which 
 they are prescribed. 
 
57 
 
 The use of opiates is necessary also, to check the pre* 
 fuse diarrhoeas, which now alternate with costiveness, 
 and reduce the already debilitated patient. With the 
 same view, the chalk mixture may be used with advantage, 
 and the astringent medicines, Kino and Catechu, with 
 others of the same class. 
 
 It is not unfrequent for haemoptysis to occur at this 
 period, as well as in the earlier stages of Consumption. 
 Sometimes it is the effect of some temporary excitement, 
 and may be relieved by the loss of a few ounces of blood. 
 But frequently this evacuation cannot be borne ; and the 
 haemorrhage proceeds rather from debility in the vessels 
 of the lungs, than any increased force of the circulation. 
 We must then trust to astringents — muriate of soda, sul- 
 phuric acid, and alum. 
 
 We come now to speak of the diet and regimen of 
 
 patients labouring under Phthisis Pulmonalis ; a subject 
 
 no less important than the remedies to be exhibited. In 
 
 the first stage, the diet should be perfectly simple, and 
 
 such as will least tend to increase the inflammatory action 
 
 of the system. For this purpose nothing is better than 
 
 milk. So sensible have physicians, at all times, been of 
 
 its propriety, that in many cases, they have trusted the 
 
 cure entirely to a milk diet. It is highly spoken of by 
 
 almost every author who has written on this subject, 
 
 and with reason. It is light, easily digested, and does not 
 
 produce any excitement. Many have preferred Asses' to 
 
 Cows' milk, but it does not appear that there is any material 
 
 difference, which should influence our choice. The 
 
 H 
 
58 
 
 former is thinner and less nutritious, and perhaps, U» 
 very delicate stomachs, may be more acceptable ; but in 
 general, the latter is as useful. Milk, however, is very 
 offensive to some stomachs, and not so easily digested as 
 other food; in such cases it must necessarily be pro- 
 hibited. 
 
 As a general rule, with regard to diet, in this stage, 
 animal food is improper, and the patient should be con- 
 fined to the use of vegetables. Fresh sub-acid fruits are 
 proper ; and, indeed, of so much importance have they 
 been considered, that Hoffman mentions a case of con- 
 firmed phthisis, cured by confining the patient to the use 
 of fruits, and particularly strawberries. Mucilaginous and 
 diluent drinks, as those formed from barley, sago and flax- 
 seed are also useful. Among these may be classed, the 
 Lichen Islandicus, which has gained with some the reputa- 
 tion of curing Consumption. Weak is the foundation for 
 hope of toose who depend on it. As an article of diet, 
 from its mucilaginous property, it is useful ; and in t'l e 
 last stage, from its possessing slightly better and tonic 
 virtues, it is also proper ; but as a remedy for phthisis it 
 is altogether inert. Nor are its tonic powers sufficiently 
 great, to render it injurious in the early stage of the 
 disease. 
 
 The dress of the patient should also be regulated by 
 the Physician. He should be clothed in flannel, and 
 this frequently changed. A constant determination is 
 thus kept up to the surface, and to some extent, diverted 
 from the chest. At the same time, all exposure to cold, 
 
moisture, or sudden alternations of temperature must be 
 studiously avoided. As in many cases, they lay the founda- 
 tion for consumption, so after it has commenced, their 
 -repetition aggravates it. 
 
 Mental distress and consequent despondence, impedes 
 the cure of those who otherwise might recover^ and should 
 be obviated as much as possible. Happily, patients labour- 
 ing under Phthisis, generally with difficulty, resign hopes of 
 recovery, and despondence from that source does not often 
 depress them. But mental anxiety, produced by other 
 causes, is very injurious. It should be relieved, as much 
 as possible, by pleasant amusements, a journey, a sea-voyage 
 or any other method most suited to the particular circum- 
 stances of the patient. 
 
 In the second stage of Consumption, the diet of the pa- 
 tient must be altered, as well as the medical treatment. The 
 most nutritious articles of food are then to be chosen, 
 and such as are at the same time the most easily di- 
 gested. It is we'll ascertained that the older meats, as 
 beef and mutton, possess these properties in a higher de- 
 gree than veal or lamb ; and generally, the brown more than 
 white meats. With the same view, w^ild fowl and game 
 generally, form nutritious articles of diet, proper for con- 
 sumptive patients. Eggs combine a large quantity of nour- 
 ishment in a small compass, and may be freely used. They 
 should be taken either quite raw, or boiled a very few 
 minutes. When boiled hard, they form one of the most 
 indigestible and offensive substances,to the delicate stomach, 
 thai: are used in diet. The various culinary preparations, 
 of which eggs form a principal part, are for the same rea^ 
 
60 
 
 sons proper. Jellies also contain a great quantity of nu- 
 tritious matter, and are very acceptible to patients, who, as 
 in Consumption, have little appetite. Oysters and some 
 other of the testacea, are also extremely nutritious. Isin- 
 glass boiled in milk is frequently in use, and with advantage, 
 in these cases. Of the vegetable nourishments, those should 
 be chosen which are most nutritious and abounding in mu- 
 cilage, as rice, sago, arrowroot and Tapioca. Chocolate^ 
 when prepared in such a manner as to be free from oily 
 matter, is a very pleasant article of diet. 
 
 The drinks of the patient should also be stimulating and 
 nutritious. Malt liquors combine both these properties with 
 some tonic virtues, which they obtain from the bitter of 
 the hops infused in them, and therefore constitute the best 
 drink for consumptive patients. Wine, also, may be used 
 moderately with advantage, but requires some caution ; and 
 should be immediately abandoned, if any undue excitement 
 be produced by it. 
 
 In this, as in every other stage of Consumption, while 
 the patient has sufficient strength, exercise is neces- 
 sary to the recovery of health. Of so much importance 
 is exercise, that in many cases, it has alone cured this dis- 
 ease. Dr. Rush relates many such cases, and particularly ^ 
 three instances of persons in confirmed consumptions, per- 
 fectly cured by the hardships of a military life. Of so 
 much consequence was it in the eyes of Sydenham, that he 
 pronounced riding on horseback, as certain a cure for con- 
 sumptions, as bark for an intermittent fever. Indeed, all 
 Writers on this disease join in recommending it, not onty 
 
61 
 
 as a part of the regimen, but as a principal remedy in the 
 treatment. The mode of exercise to be chosen* should de- 
 pend entirely on the situation of the patient, at the time. 
 While much pain and soreness subsist, denoting the pre- 
 sence of active inflammation, the most gentle exercise only 
 should be % used : at that time riding in a carriage or on 
 horseback, would be as improper as for a patient labouring 
 under pleurisy. The swing, so highly recommended by 
 Dr. Carmichael Smyth, is the least fatiguing, and most 
 gentle mode that can be adopted. It may be serviceable, 
 too, when the patient is too much debilitated to bear other 
 more fatiguing exercise. But I would, by no means, adopt 
 the opinion of Carmichael Smyth, that the swing, in itself, 
 and unassisted by other remedies, will cure Consumption, 
 Experience has proved the contrary ; and has taught us 
 that it is only useful as an article of regimen, while the pa- 
 tient is under the influence of other more powerful reme- 
 dies. When there is sufficient strength to bear it, and 
 not too much excitement, riding in an easy carriage is the 
 next mode of gestation which may be used. But when the 
 patient is enabled to ride on horseback, we have more to ex- 
 pect from it, than any other species of exercise, To attain 
 the greatest benefit from it, it should be made use of regu- 
 larly and constantly ; not during the cold air of early 
 morning, nor the dews of the evening, but rather during the 
 day, after the sun exerts some influence. A long journey 
 on horseback aflbrds the most useful method of obtaining 
 all the advantages that can be derived from exercise. It is 
 then made constant and regular ; and the amusement af- 
 
62 
 
 forded by travelling serves to divert the patient's mind 
 from his own feelings, and adds to its beneficial effects. 
 
 Secondary Phthisis Pulmonalis remains yet to be treated 
 of. Under this order, should be included every form of Con- 
 sumption, in which the system has become debilitated by 
 any cause, and the lungs in consequence become affected. 
 I would exclude from it that form of the disease occurring 
 after measles, scarlatina, and some other eruptive diseases, 
 which I would consider as primary Phthisis Pulmonalis ; 
 because, in those cases, the lungs do not become affected 
 merely in consequence of debility, but these diseases seem 
 rather to act as exciting causes, in constitutions already 
 predisposed to Consumption ; w^hile in secondary Phthisis, 
 the affection of the lungs is only one symptom of the gene- 
 ral disease, which is wasting the body. Nor would the 
 treatment, which will be advocated in the latter form, be 
 prober in the cases alluded to. They require that, which 
 should be used in the first species of Phthisis, and which 
 has already been detailed. The reason, why the lungs be- 
 come affected in consequence of debility induced by parti- 
 cular causes, I would not attempt to explain. It is one of 
 those laws of the constitution, not better understood, than 
 why particular parts are successively affected in conse- 
 quence of syphilis, or that the breasts and lower extremities 
 are more liable to disease than other parts, except the ute- 
 rus, in females after parturition. Many laws of this kind 
 exist in the human constitution, of whose effects, we are 
 every day made sensible, but of the cause of which we arc 
 totally ignorant. 
 
63 
 
 One of the most frequent causes of Secondary Phthisis^ 
 is Chlorosis, that disease which occurs in young females, in 
 consequence of Retention of the menses. The constitution 
 not having sufficient vigour to produce this evacuation at 
 the proper period, if any predisposition to Phthisis exist, 
 a determination takes place to the lungs, producing Phthi- 
 sical disease. This case is not analogous to Consumption 
 produced by Suppression of the menses, after they have 
 been once established ; for in that instance the suppression 
 is not generally induced by debility, but by cold^ or some 
 other cause, not acting merely by weakening the patient ; 
 and it produces active inflammation of the lungs. But in 
 the case before us, the affection of the lungs is merely a 
 symptom of the want of vigour in the constitution, which 
 shews itself in retention of the menses. Accordingly, in the 
 treatment of this disease, our attention must not be direct- 
 ed primarily to the affection of the lungs, but to the state 
 of the system, the cause of that affection. 
 
 Profuse evacuations, of any kind, may be the cause of 
 Secondary Phthisis. Haemorrhages from the Nose, Lungs, 
 Stomach, Kidneys and wounds are all mentioned by Mor- 
 ton, as having induced Pulmonary disease. Mr Hey, in 
 his work on Surgery, observes^ that he has seen a great ma- 
 ny cases of pulmonary Consumption, the consequence of 
 debility, induced by violent haemorrhages, and in persons 
 who had no apparent tendency to Consumption. In the 
 same manner, loss of blood from Haemorrhoids and in 
 Menorrhagia, may act as causes. Debilitating evacuations, 
 by means of Diarrhcsa, Diabetes, Salivation, and Sweatings 
 
64 
 
 have had the same effect. But the most frequent causes of 
 this class are, immoderate discharges by flucr alius, and too 
 long suckling by delicate woman of robust children. They 
 are particularly mentioned by Morton and Fothergill, and 
 have been adverted to by most authors, who have written 
 since. 
 
 Chronic Catarrh, terminating in Phthisis, may be rank- 
 ed also in this class. The profuse and long continued dis- 
 charge from the membrane lining the trachea and bronchia?, 
 is the debilitating agent in that case. 
 
 Long continued Fevers, and particularly Intermittent 
 fevers, not unfrequently leave behind them, a state of de- 
 bility, sufficient to induce Consumption. 
 
 In the New- York Hospital, frequent instances occur of 
 Consumption induced by intemperance in the use of ardent 
 spirits. This habit destroys the tone of the stomach, 
 which becomes primarily affected, and in consequence the 
 whole system becomes debilitated, terminating in disease 
 of the Lungs. 
 
 Secondary Consumption has also been induced by some 
 other preceeding diseases, such as Scurvy and Syphilis, 
 and requires the attention of the Physician, to the primary 
 disease rather than to the affection of the Lungs. 
 
 In the treatment of Pulmonary Consumption, arising from 
 any of these or analogous causes, cur attention is first cal- 
 led to the removal of the primary source of the disease. 
 If it be Chlorosis, remedies, calculated to cure that malady, 
 must be prescribed. If profuse evacuations are the cause, 
 all the means in our power, must be employed in restraining 
 
65 
 
 those evacuations. If the disease has been induced bv the 
 long continued suckling of a vigorous child, bv a delicate 
 mother, another nurse mnst be provided, or the child must 
 be weaned. If Scurvy or Syphilis have produced it, the 
 proper remedies for those disorders must be employed. 
 
 Our next object is to remove the debility, the cause of 
 the pulmonary symptoms. For this purpose, Tonics are in- 
 dicated, and at their head stands the Peruvian Bark. In the 
 other species of Phthisis, this medicine has been much 
 abused, but in the present one, its use is sanctioned by ex- 
 perience. In the cases proceeding from Leucorrhcea, and 
 long suckling, it is highly recommended by Dr Fothergill; 
 but he cautions us against persevering in its use, longer 
 than while it is doing good ,* and remarks, that if the 
 breathing become more ppressed, the cough drv, the pulse 
 more quick and hard, and especially, if slight transitory- 
 pains or stitches about the thorax, are more frequently 
 complained of, a perseverance in the use of he 
 bark will increase the disease. If, in consequence of ihis 
 increase of symptoms, we are obliged to desist in 
 the use of the Bark, other Tonics must be substituted. 
 The combination of bitter and tonic medicines in the Infus: 
 Amar: of the dispensatories may be then usefully prescri- 
 bed. Columbo, which is sometimes an ingredient in that 
 formula, is particularly recommended by Dr. Thomas Per- 
 cival, as not possessing any of the injurious properties of 
 bark. 
 
 The Elixir of Vitriol is also an excellent tonic, and may 
 be usefully given at the same time with the remedies just 
 
66 
 
 proposed. But it requires to be administered with the 
 same cautious hand as the bark, and to be discontinued, if 
 the symptoms appear to be at all aggravated by its use. In 
 general, no ill effects arise from it, but if the determination 
 to the chest be so great, as to produce much inflammatory 
 action, it may do injury. Independent of its tonic powers^ 
 it will be serviceable in checking any disposition, which 
 may exist, to profuse sweating. 
 
 Iron, in its various officinal preparations, is also a good 
 remedy, in this form of phthisis. Although, highly 
 dangerous in the primary disease, there is now little dan- 
 ger of increasing the inflammation, which in that form, 
 made it improper. Mineral chalybeate waters, will in this 
 instance, be useful, not only by the journey to them, and 
 the amusement derived at watering places, but may be 
 drank with advantage by the patient. 
 
 In addition to these remedies, the diet and regimen 
 should be such as is most invigorating to the constitution. 
 A nutritious diet and the moderate use of wine will be pro- 
 per ; and country air and exercise with the same rules as 
 were mentioned in the treatment of primary phthisis, are 
 very important circumstances in the cure of the secondary 
 form. A long journey, a sea-voyage and change of climate 
 are also equally proper. 
 
 The prominent feature and primary object of this es- 
 say has been, to establish the distinction between primary 
 
B7 
 
 and secondary Phthisis Pulmonalis. Although, perhaps, 
 the minute parts of the arrangement may not have been 
 distributed, in every instance, with perfect accuracy, I 
 feel confident that the general plan is correct. Farther 
 observation and experience will probably suggest a more 
 accurate disposition of the varieties of Phthisis, under the 
 two orders which I have proposed. 
 
 Probably from the want of the distinction between 
 primary and secondary Phthisis, may be explained the 
 Various and contradictory practice, proposed by physicians 
 of deserved eminence. A more frequent opportunity of 
 observing one or the other form of the disease, has de- 
 termined with each, his mode of treatment : and hence in 
 diseases bearing the same name, we may see blood-letting 
 and a rigid antiphlogistic regimen adopted by one party, 
 and bark, iron, and a nutritious diet by another. Any 
 error which may arise from these contradictions, may 
 be corrected by the distinction, which has been pro- 
 posed. 
 
 It has also been my object, to call the attention of the 
 practitioner, to the earliest symptoms and first dawnings 
 of Consumption. W ere they not so much neglected by 
 the physician, as well as the patient, our bills of mortality 
 would not continue to present so frightful a picture of the 
 ravages of this disease ; while, on the other hand, a prompt 
 attention to these incipient symptoms, and the interference 
 of an active practice, would afford a reasonable prospect 
 of saving many from Consumption, who are now it* 
 victims. 
 
ERRATA, 
 
 Page 10, Note, for tfapres, read D apres. 
 
 22, line 25, for which like the inert physician^ read which the inert 
 
 physician. 
 25, line 13, for dysentery^ read dysentery. 
 
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